AMERICAN HEART ASSOCIATIONCOUNCIL ON CLINICAL CARDIOLOGY

CRITERIA FOR FELLOWSHIP& INSTRUCTIONS FOR COMPLETING APPLICATIONS

DESCRIPTION AND TYPES OF FELLOWSHIP

A. FELLOWSHIPThe Leadership Committee of the Council on Clinical Cardiology of the American Heart Association in concert with the AHA’s Science Advisory and Coordinating Committee has established the criteria for the designation Fellow of the American Heart Association (FAHA). Eligible members are elected to become FAHA through the Council. AHA Fellowship in the Council recognizes excellence and leadership in clinical cardiology in the private practice or academic setting. Fellowship is generally reserved for physicians and scientists who are board certified in cardiovascular disease1. Council members are eligible for Fellowship and must be able to demonstrate ongoing involvement in activities that reflect significant and current service to the American Heart Association2.

1. In exceptional circumstances, at the discretion of the Leadership Committee of the Council on Clinical Cardiology, Fellowship may be granted to an individual who does not have subspecialty boards in cardiovascular disease. Candidates without subspecialty board certification must have equivalent credentials which the Proposer and Seconder adequately document in letters. Credentials equivalent to U.S. or Canadian subspecialty board certification may include overseas credentialing if comparable, academic credentials, and acknowledged stature as a consultant in cardiovascular disease.

CRITERIA FOR FELLOWSHIP:The candidate for Fellowship must be:

A physician or medical scientist who is a citizen or permanent resident of the United States or Canada. Board certified in cardiovascular disease (see 1 above). Recognized by her/his peers as a competent physician consultant in cardiovascular disease who holds

herself/himself to the highest ethical standards of professional behavior. Able to demonstrate significant and current service to the American Heart Association2

Active member of the Council on Clinical Cardiology.

2. The candidate should outline her/his involvement in one or more of the following activities that reflect significant and current service to the American Heart Association. Examples include, but are not limited to:

1) Active participation on committees or boards at the AHA division, affiliate, national or council level.2) Participation and /or leadership in the areas of:

a) Development/fundraising – e.g. heart walks, galas, etc.b) Advocacy – e.g. lobbying efforts at local/ national levelc) Programs – professional and/or lay education; AHA writing groups; program or abstract grading

committees at AHA Scientific Sessions or AHA conferences; speakers bureau; Operation Heartbeat; Operation Stroke; Get with the Guidelines; etc.

d) Research peer review – e.g. grant review at local/national level; journal review for AHA scientific journals.

Letters of Recommendation must cite specific activities and accomplishments that relate to the criteria outlined above.

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Fellows of the American Heart Association must maintain their membership at the Premium Professional Level. In addition to the benefits of Premium Professional membership listed below, Fellows will:

Receive the designation Fellow of the American Heart Association (FAHA) Receive a Certificate of Fellowship Receive the print subscription to Circulation or Circulation Research.

Benefits of Premium Professional Membership: Affiliate with up to two Councils (a primary and a secondary Council) and one Interdisciplinary Working

Group (IWG). Choose to affiliate with a third council for an additional $50/year Be eligible to hold positions such as national science officer, board member, committee member, council

officer, journal editor, etc. Mentor young healthcare professionals. Save 25% on print subscriptions to AHA scientific journals. Save on registration to AHA scientific meetings: 40% off Scientific Sessions (advanced registration). Significant savings on registration to other AHA scientific meetings. Use online tools available through My AmericanHeart for Professionals (my.americanheart.org) to access: Five AHA scientific journals. Core clinical textbook content from Lippincott Williams & Wilkins. Bi-weekly Clinical Updates from experts. Continually updated Facts & Comparison drug database. Preview articles to be published in AHA scientific journals.

B. INTERNATIONAL FELLOWSHIP

Candidates for International Fellowship must be physicians or non-physician medical scientists who reside permanently outside of the United States or Canada. The candidate must be of good character, ethical in his or her practice, and have good standing in the community. Candidate must be continually active in the practice of cardiology or in scientific or educational work bearing directly on cardiology.

All candidates must be considered on the basis of the following qualifications: outstanding service reflecting the goals and mission of AHA, and should be considered equivalent to those as outlined 2; outstanding scholastic or academic achievement; national and international recognition as a cardiologist or cardiovascular scientist; outstanding service to the appropriate cardiovascular societies or organizations of his or her country of residence; publications, lectureships, visiting professorships, and other documents in support of the candidate’s contributions.

Except under unusual circumstances, candidates should be certified by the appropriate cardiovascular certification organization of the country in which they received their cardiovascular training or by the similar organization in their country of residence if such an organization exists.

International Fellows shall receive all of the privileges of Fellowship.

C. HONORARY FELLOWSHIP

The Leadership Committee may, under special circumstances, designate a limited number of outstanding physicians or scientists in the field of cardiology as Honorary Fellows.

D. EMERITUS FELLOWSHIP

Emeritus status may be granted upon request, in writing, after a Fellow has reached the age of 65. Emeritus Fellows shall have all of the rights and privileges of Fellows, but are not required to pay dues.

REVIEW BY THE MEMBERSHIP/CREDENTIALS COMMITTEE

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Based upon the information submitted in the Fellowship application, the Membership and Communications Committee will recommend whether:

1. A candidate should be ELECTED to Fellowship or International Fellowship;2. The proposal should be DEFERRED;

3. The proposal should be DECLINED.

THESE RECOMMENDATIONS ARE BASED UPON CRITERIA APPROVED BY THE LEADERSHIP COMMITTEE OF THE COUNCIL ON CLINICAL CARDIOLOGY.

COMPLETING THE FELLOWSHIP APPLICATION

A. CANDIDATE

1. Type all information and answer all applicable questions. Handwritten applications and/or applications which are not completed correctly will be returned to the candidate (i.e., candidate states “Please see attached CV” for any of the questions or fails to include curriculum vitae or supporting documents).

2. If space provided is inadequate for completing any portion of the application, attach the additional information to the back of the application.

3. Sign the application.

4. Include a copy of candidate’s curriculum vitae, including bibliography.

5. Send the completed application including Criteria and Instructions to the Proposer and provide him/her with the name and address of the Seconder. (After approving the application and attaching a letter of support, the Proposer will forward the application to the Seconder for his/her approval and letter of support.)

B. PROPOSER AND SECONDER

1. Must be Fellows of the American Heart Association and members of the Council on Clinical Cardiology.

2. Must review and ensure completeness of application, denote approval with his/her signature, and attach letter of support. [See note below]

PROPOSER AND SECONDER PLEASE NOTE:

As you prepare your letter supporting a person interested in applying for AHA Fellowship in the Council on Clinical Cardiology, you are encouraged to carefully read the Criteria for Fellowship/International Fellowship and Instructions for Completing Fellowship Applications. The Council is especially interested in ensuring that individuals applying for Fellowship can demonstrate involvement in activities that further the mission of the AHA. The instruction sheet is quite explicit on this matter. It would be helpful, especially in instances where the candidate is not in full-time academics, to specify what their “involvement in clinical and/or academic activities that reflect the mission of the American Heart Association” and “public service in the area of cardiovascular disease” are. If you have further questions, do not hesitate to contact the Credentials Secretary.

3. Proposer should send application to Seconder. Seconder should mail the completed and approved application and supporting documents to: Credentials Secretary, Scientific Councils, American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231-4596. The Credentials Secretary can be reached at (214) 706-1587 or FAX (214) 373-3406.

AMERICAN HEART ASSOCIATION

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COUNCIL ON CLINICAL CARDIOLOGY

APPLICATION FOR FELLOWSHIP OR INTERNATIONAL FELLOWSHIP

The Council on Clinical Cardiology of the American Heart Association promotes excellence in patient care, education and clinical research in cardiovascular disease.

APPLICATIONS MUST BE SUBMITTED BY JANUARY 15 OR JUNE 1

PLEASE TYPE ALL INFORMATION.COMPLETED FORM MUST BE ACCOMPANIED BY CURRICULUM VITAE AND

LETTERS OF RECOMMENDATION FROM PROPOSER AND SECONDER.

We, the undersigned, propose the person named below for Fellowship in the American Heart Association in the Council on Clinical Cardiology, and herewith submit information concerning his/her qualifications for consideration by the Membership and Communications Committee for: ( ) FELLOWSHIP or( ) INTERNATIONAL FELLOWSHIP

(1) Full Name of Candidate with Degree(s) - as it should appear on the Fellowship certificate:

______________________________________________________________________________

(2) Office Address:

______________________________________________________________________________

______________________________________________________________________________

Telephone Number________________________ Fax Number_____________________________

Email_________________________ _______________________________________________

(3) Place of Birth_____________________________ Date of Birth____________________________

(4) Citizen of_______________________________________________________________________

( ) U.S. Born ( ) U.S. Naturalized - When?_______________________ ( ) N/A

( ) U.S. Visa Type______________________ Date_______________ ( ) N/A

(5) Intend to obtain U.S. citizenship? ( ) Yes ( ) No ( ) N/A

Intend to remain in U.S.? ( ) Yes ( ) No ( ) N/A

(6) Education: Institution/Location Graduation Date Degree

College _________________________________________________________________

_________________________________________________________________

Medical _________________________________________________________________

_________________________________________________________________

(7) Internship - Institution/Location:

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______________________________________________________________________________

Inclusive dates__________________________________________________________________

(8) Graduate Education - Residencies, Fellowships or other formal graduate work:

Institution/Location Field of Study Inclusive Dates

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

(9) Licensed to practice in what State(s)_________________________________________________

(10) Practice limited to Internal Medicine and/or Cardiology since______________________________

(11) U.S. ONLY - If certified by the American Board of Internal Medicine, show certification date and

number________________________________________________________________________

(12) U.S. ONLY - If certified by the Subspecialty Board in Cardiovascular Disease, show certification date

and number_____________________________________________________________________

(13) Is the candidate currently in private practice? ( ) Yes ( ) No

If yes, where?___________________________________________________________________

(14) Is the candidate engaged in teaching? ( ) Yes ( ) No

If yes, explain:___________________________________________________________________

(15) Is the candidate engaged in research? ( ) Yes ( ) No

If yes, explain:___________________________________________________________________

(16) Is the candidate engaged in full-time academic medicine? ( ) Yes ( ) No

(17) List public service in the area of cardiovascular disease (e.g., public lectures, participation in public education, local AHA affiliate/division involvement (U.S. ONLY), etc.) (required):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

18) Special qualifications or other relevant information not previously mentioned:

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______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

THE MEMBERSHIP/CREDENTIALS COMMITTEE REQUESTS THAT EACH OF THE FELLOWS SIGNING THIS APPLICATION EXPLICITLY FOLLOW THE DIRECTIONS ACCOMPANYING THIS FORM.

IF THE CRITERIA AND INSTRUCTIONS ARE MISSING, PLEASE CONTACT THE CREDENTIALS SECRETARY.

(19) Proposer ___________________________________________________________Signature Date

___________________________________________________________Address

___________________________________________________________Address

___________________________________________________________Phone Number Fax Number

____________________________Email Please remember to attach a letter of support

(20) Seconder ___________________________________________________________Signature Date

___________________________________________________________Address

___________________________________________________________Address

___________________________________________________________Phone Number Fax Number

____________________________Email

Please remember to attach a letter of support

(21) Candidate ___________________________________________________________Signature Date

Month and Year of Birth ________/_________ Gender: M FRace/Ethnicity:_ % of time spent (=100%):African American ___ AdministrativeAlaskan Native ____ Patient CareAmerican Native ___ ResearchAsian _ ___ TeachingPacific Islander Hispanic Caucasian

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JOURNAL SELECTION FORM

AHA Fellows via the Council on Clinical Cardiology are required to maintain their membership at the Premium Professional Level and must subscribe to one of the two journals, Circulation or Circulation Research.

Please indicate on this form which of the two journals you would like to receive and return the form to us with your fellowship proposal.

By notifying us in advance of your journal preference, your subscription and membership records can be coordinated.

Upon election to fellowship you will be billed:

U.S. DUES

$356.00 includes subscription to Circulation $379.00 includes subscription to Circulation Research

NON-U.S. DUES

$503.00 includes subscription price to Circulation $433.00 includes subscription to Circulation Research

Please check one: [ ] Circulation [ ] Circulation Research

BILL TO:

Name: _________________________________________________________________

Address: _________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

If you are a current subscriber, please state your account number:

#____________________________________________________

Subscription Rates Effective through December 2004

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